D.C. Week: CMS Issues First State Medicaid Scorecards

Also: Medicare Trust Fund to run dry 3 years sooner than expected

WASHINGTON -- The Trump administration released a scorecard system to rate state Medicaid program performance, but hasn't said how the ratings will be used. Also this week, Medicare trustees projected that the hospital insurance trust fund will run out in 2026.

CMS Issues First Round of State Medicaid Scorecards

How effective are state Medicaid programs in helping patients control blood pressure? How likely is a beneficiary to get follow-up care after a mental health-related hospitalization? What proportion of children enrolled in the program are receiving multiple antipsychotics?

"The ultimate goal of the scorecards is to allow every American to see how well the Medicaid program is doing in improving the lives of its recipients and delivering value to taxpayers, so that they can hold CMS [the Centers for Medicare & Medicaid Services], as well as state leaders that administer the Medicaid programs in their states, accountable for our performance," said CMS administrator Seema Verma in releasing the first set of scorecards on Monday.

However, the scorecards are based on individual states' voluntary data submissions. In addition, much of the data in the State Health System Performance pillar is not new, with most culled from the CMS Medicaid/CHIP Child and Adult Core Set, according to the website.

"The message ... has always been the same, which is, at some point, the program is going to face huge financial challenges unless policy makers take action, and unless the health sector finds ways to deliver appropriate care more efficiently to patients," said Joseph Antos, PhD, a resident scholar in healthcare and retirement policy at the American Enterprise Institute (AEI).

At an AEI briefing Wednesday, Antos, along with Robert Moffit, PhD, a senior fellow at the Heritage Foundation, did highlight several shortcomings of the 2018 Medicare Trustees Report, such as the lack of independent expert involvement.

This year's report was signed only by Trump administration officials, noted Moffit. Such reports should be reviewed by independent experts to "instill confidence" in the findings, he pointed out.

The wage index is a formula that adjusts Medicare provider payments to account for geographic area differences in hospital wage levels as compared with other hospitals nationwide. "This is a huge problem across the country," said Rep. Phil Roe, MD (R-Tenn.). In the area Roe represents, the wage index is 0.72, so Medicare reimbursement for providers there is lower than in other places.

"It makes it difficult for us to [recruit] physicians and for us to get [hospital] staff because we can't keep them," whereas hospitals in California and New York have wage indexes at 1.6 or 1.7, he said. "It's really harming rural America."

Rep. Bradley Byrne (R-Ala.) agreed. "We have a crisis in rural America with regard to small hospitals ... [in my area] we have lost 12 in the law few years -- we lost the last one 3 weeks ago. It's a crisis and we're going to lose more hospitals if we don't do something," he said, and asked HHS Secretary Alex Azar to "please tell me what Congress can do."

The original drug is sold as Neulasta. Fulphila, made by Mylan, is approved for use in patients at high risk for infection due to neutropenia as a result of myelosuppressive chemotherapy. Both agents are synthetic versions of human granulocyte colony-stimulating factor.

Clinical trials and animal and laboratory established that Fulphila (with the official generic name pegfilgrastim-jmdb) is functionally equivalent to Neulasta in terms of clinical efficacy, safety, pharmacodynamics, and pharmacokinetics. However, the biosimilar is not approved to be interchangeable with the original agent, which would require a different and more elaborate set of studies.

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